Provider Demographics
NPI:1932263217
Name:SMITH, CHRYSTAL JEAN (L,CSW)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:L,CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 DOUBLE CHURCHES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2605
Mailing Address - Country:US
Mailing Address - Phone:706-681-3278
Mailing Address - Fax:706-321-9757
Practice Address - Street 1:1410 DOUBLE CHURCHES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-2605
Practice Address - Country:US
Practice Address - Phone:706-681-3278
Practice Address - Fax:706-321-9757
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0031231041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator